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MAKING SENSE OF WHAT COMES NEXT

Next Things First focuses on aspects of the health care system’s "death by a thousand cuts," highlighting the innovators who are bringing solutions to the market and analyzing the challenges these entrepreneurs face in growing their businesses.

HealthLeaders Media recently compiled 10 mini-articles dealing with various scenarios: What if safety-net hospitals start to fail? What if the uninsured hit 75 million? What if people actually start taking care of themselves? And the like.

An interesting editorial concept, because, really, who knows what will happen next? All 10 scenarios are based on current (actual) trends, and the authors just take them to their extremes. And while doing so, shed some light on potential innovations that could help a system that seems to be cracking more and more every day.

Consider: What if primary care physicians become extinct? The writer covering this scenario summarizes the important role primary care physicians play, after telling us that they might disappear because of, guess what, money (or “the growing compensation disparities between specialists and primary-care doctors”):

… Sure, nurse practitioners and physician assistants can handle some of the preventive care if that [the disappearance of PCPs] happens. Primary-care doctors often cite routine cancer screenings and immunizations among their irreplaceable preventive services, but those can and will be handled by nonphysicians. It’s when a patient has multiple severe medical problems that the primary-care doctor’s coordination will be missed. Specialists can individually treat hypertension, diabetes, arthritis, and depression, but when one patient has all four conditions, how will they be managed? They won’t.

The piece also provides an interesting perspective on wellness:

What if Americans listened to their doctors and exercised, ate healthier, and stopped smoking? The trend of chronically ill Americans-more than 130 million people-would be reversed. The country’s healthcare system could actually change its focus from sickness to health. …

“We have to be very careful how we analyze this, because one person’s benefit will be another person’s detriment,” says David B. Nash, MD, MBA, chair of the department of health policy at Jefferson Medical College of Thomas Jefferson University in Philadelphia.

The biggest winners in a healthier society would be patients and employers. Healthier Americans would live longer lives. Employers would not have to pay an increasing percentage of their budgets on healthcare, but could allocate the money into salaries, products, and infrastructure. …

But what about providers? Nash says only 3% of the American population follow four basic wellness goals: Don’t smoke, stay close to your ideal body weight, exercise three times a week for at least 20 minutes, and eat fruits and vegetables regularly. If that percentage increased to a mere 9% of the population, Nash says, hospitals would see a large drop in admissions for bronchitis and upper respiratory problems, heart attacks and strokes, and diabetes. In short, healthier Americans would force physicians and hospitals to make changes.

Want one more? What if universal health care happens?

… who would provide care for all the newly insured patients? Massachusetts, which has one of the highest rates of physicians per capita, doesn’t have enough primary-care docs to meet the demand. So imagine what might happen in Texas, a state with one of the lowest rates of docs per capita and more than 5.5 million uninsured, or 25% of the population.

“It may push providers, hospitals, and the government to start thinking more about efficiency, cost effectiveness, and controlling costs,” says [Michael] Doonan.